1915(i) Home and Community Based State (HCBS) Plan Benefit (CMS-10259)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 1915(i) State Plan HCBS Benefit (CMS-10259)	Form and Instruction	New	Repair queued
FR copy of 2249-P.pdf	Supplementary Document	Uploaded 2008-11-07	Repair queued
CMSO State Plan HCBS PRA Supporting Statement 10-2-08.doc	Supporting Statement A	Uploaded 2008-11-07	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
188695	1915(i) State Plan HCBS Benefit (CMS-10259)	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 200904-0938-005
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: 1915(i) Home and Community Based State (HCBS) Plan Benefit (CMS-10259)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 06/16/2009
	Date Received in OIRA: 04/06/2009
Terms of Clearance: CMS has agreed to re-submit this ICR and re-publish the 30-day notice at such time when the associated rule is under consideration.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 6086 of the Deficit Reduction Act expanded access to Home and Community-Based Services for elderly and disabled by adding Section 1915(i) to the Social Security Act. Under 1915(i), States can amend their State plans to add these services. The draft template includes the information needed by CMS to determine whether the State's services will meet the requirements under 1915(i) and 42 CFR 559, 574, and 577.

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Authorizing Statute(s): PL: Pub.L. 109 - 171 6086 Name of Law: Expanded Access to Home and Community-Based Services
   US Code: 42 USC 1396n(i) Name of Law: State Plan Option
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AO53	Proposed rulemaking	73 FR 18676	04/14/2008

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 13910	03/14/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 11732	03/19/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
1915(i) State Plan HCBS Benefit (CMS-10259)	1	1915(i) State Plan Home and Community-Based Services Administration and Operation

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Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection.

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Annual Cost to Federal Government: $23,000,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/06/2009

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